FCPS

Oral & Maxillo-

Facial Surgery
ASSESSMENT

FORMATIVE ASSESSMENT:

College of Physicians and Surgeons Pakistan, in order to implement competency based education in letter
and spirit, is introducing Work Place Based Assessment (WPBA) in addition to institutional/ departmental
assessments. To begin with college is introducing Mini-CEX and DOPS to ensure that the graduates are fully
equipped with the clinical competencies.

Mini Clinical Evaluation Exercise (Mini-CEX)

During training in FCPS Oral and Maxillo-Facial Surgery, at least one Mini-CEX in each quarter is to be
conducted from the list given below.

 Mini-CEX is entirely a formative tool of assessment and is to be accompanied with constructive feedback
 Each Mini-CEX encounter extends for about 20 minutes with 05 minutes for feedback and further action
plan
 The topics given below can be covered In any order as per availability of case; however each time focus
should be on a different area/topic.
 The resident has the onus to report to the Supervisor when he/she is prepared to appear for Mini-CEX
 The Supervisor will arrange for the session of Mini-CEX and after completing the session will retrieve
online prescribed assessment form (sample given below), fill it and make entries online (e-portal)
 In case of unsatisfactory performance of the resident, a remedial has to be completed within stipulated
time frame
 Non-compliance by the resident has to be reported in quarterly feedback

Topics for Mini-CEX

 Examination of Neck Nodes (U/L and B/L) in Infection

 Examination of Cheek Swelling
 Examination of TMJ
 Examination of Parotid Gland Swelling
 Examination of Sub-mandibular Swelling
 History-taking & Examination / Diagnosis of Trigeminal Neuralgia
 Examination of Maxilla Fracture
 Examination of Mandible Fracture
 Examination of Zygomatic Bone Fracture
 Examination of Blowout Fracture
 Examination of Naso-orbito-ethmoidal Fracture
 Examination of Bony Swelling in Mandible (Cyst or Tumor)
 COLLEGE OF
OF PHYSICIANS AND MINI CLINICAL EVALUATION EXERCISE (CEX)
SURGEONS PAKISTAN

Specialty: : ____FCPS Oral & Maxillo-Facial Surgery___

Time Duration = 20 mins (15 mins assessment and 5 mins feedback)

PLEASE COMPLETE THE QUESTIONNAIRE BY FILLING/CHECKING APPROPRIATE BOXES

Assessor: _____________________________________________ Assessment Date: ___________________

Resident's Name: __________________________________________________________________________

Hospital Name:_________________________________________ R&RC Number:______________________

Year of Residency: □ R1 □ R2 □ R3 □ R4

Quarter: □ 1st □ 2nd □ 3rd □ 4th

Setting: □ Ward □ Outdoor (Hospital/Community) Others: _________________________

Diagnosis of Patient: ____________________________________ Patient Age: _______ Sex: ____________

Clinical Area: _____________________________________________________________________________

Complexity of Case/ Procedure: □ Low/Easy □ Moderate/Average □ High/Difficult □ N/A

Focus of Clinical Encounters: □ History taking □ Physical Examination □Management

□ Communication Skills □ Other

Below Above
Not Observed / Satisfactory Excellent
Please grade the following areas on the given scale: Expectation Expectation
Applicable
1 2 3 4 5
Informed Consent of patient
Interviewing Skills
Systematic Progression
Presentation of positive & significant negative findings
Justification of actions
Professionalism
Organization/Efficiency
Overall clinical competence
Assessor's Satisfaction with Mini-CEX:
(Low) 1 2 3 4 5 (High)
Resident's Satisfaction with Mini-CEX:

(Low) 1 2 3 4 5 (High)

Strengths Suggestions for Improvement

Encounter to be repeated □ YES □ NO

Signature
GUIDELINES FOR MINI-CEX ASSESSMENT

GENERIC
 During Examination, head should be in appropriate position.

TOPIC-SPECIFIC
 Examination of neck nodes (U/L and B/L) in infection
 Findings for nodes to be noted in anterior and posterior triangle of neck: Site, Size, Shape,
Number, Tenderness, Consistency (Matted, Firm, Attached), etc.

 Examination of Cheek swelling

 Findings to be noted for swelling: Site, Size, Shape, Tenderness, Consistency (Firm,
Attached), etc.

 Examination of TMJ.
 All the findings are to be noted while patient opens and closes mouth
 Mouth opening is to be checked
 Intra-oral examination is to be done

 Examination of Parotid gland swelling.

 All the findings for swelling are to be noted
 Intra-oral and extra-oral examination is to be done
 Saliva flow through duct is to be checked
 Comparison to normal side
 Checking for indications of nerve damage

 Examination of Sub-mandibular swelling

 All the findings for swelling are to be noted
 Intra-oral and extra-oral examination is to be done
 Bimanual palpation
 Saliva flow through duct is to be checked
 Comparison to normal side

 History-taking & Examination / Diagnosis of Trigeminal Neuralgia

 All the findings of neuralgia (severity, distribution and relief of pain, etc) are to be noted
before as well as after the use of tablet Tegral and Local Anaesthesia
 Comparison to normal side
 Examination of Maxilla Fracture
 Presence of clinical evidence of fracture is to be noted on both sides
 Checking for CSF leakage
 Eye examination

 Examination of Mandible Fracture

 Presence of clinical evidence of fracture is to be noted
 Status of occlusion of mouth
 Checking for indications of nerve damage
 Examination of Zygomatic bone Fracture
 Presence of clinical evidence of fracture is to be noted
 Status of occlusion and opening of mouth
 Checking for indications of nerve damage
 Eye examination

 Examination of Blowout Fracture

 Presence of clinical evidence of fracture is to be noted
 Checking for indications of nerve damage
 Eye examination including checking for diplopia (monocular / binocular)

 Examination of Naso-orbito-ethmoidal Fracture

 Presence of clinical evidence of fracture is to be noted
 Eye examination

 Examination of bony swelling in Mandible (Cyst or Tumor)

 All the findings for swelling are to be noted
 Checking for indications of nerve damage
Direct Observation of Procedural Skills (DOPS)
During training in FCPS Oral and Maxillo-Facial Surgery, at least one DOPS in each quarter is to be
conducted from the list given below.

 DOPS is entirely a formative tool of assessment and is to be accompanied with constructive

feedback
 Each DOPS encounter extends for about 20 minutes with 05 minutes for feedback and further
action plan
 The topics given below can be covered In any order as per availability of case; however each time
focus should be on a different topic/procedure
 The resident has the onus to report to the Supervisor when he/she is prepared to appear for DOPS
 The Supervisor will arrange for the session of DOPS, and after completing the session will access
online prescribed assessment form (sample given below), fill it and make entries online (e-portal)
 In case of unsatisfactory performance of the resident, a remedial has to be completed within
stipulated time frame
 Non-compliance by the resident has to be reported in quarterly feedback

Topics / Procedures for DOPS

 Intra-oral Interrupted Silk Suture
 Extra-oral Interrupted Silk Suture
 Incision, Flap design (Intra-orally)
 Local Anaesthesia (Infiltration, Block)
 Biopsy (Incisional)
 Arch Bar Application
 Eyelets Application
 Removal of impacted Mandibular Molar
 Surgical Endodontics / Peri-apical Surgery
 Pre-prosthetic (Mandibular ridge contouring)
 Enucleation of Cyst
 Marsupialization of Cyst
 COLLEGE OF OF
PHYSICIANS AND
DIRECT OBSERVATION OF PROCEDURAL SKILLS (DOPS)
SURGEONS PAKISTAN
Specialty: FCPS Oral & Maxillo-Facial Surgery___________
Time Duration = 20 mins (15 mins assessment and 5 mins feedback)

PLEASE COMPLETE THE QUESTIONNAIRE BY FILLING/CHECKING APPROPRIATE BOXES

Assessor: ____________________________________________ Assessment Date: ___________________

Resident's Name: _________________________________________________________________________

Hospital Name: _______________________________________ R&RC Number: ______________________

Year of Residency: □ R1 □ R2 □ R3 □ R4

Quarter: □ 1st □ 2nd □ 3rd □ 4th

Setting: □ O.T. □ Procedure Room Other:

Diagnosis of Patient: ___________________________________ Patient Age: _______ Sex: ____________

Name of Procedure: _______________________________________________________________________

Complexity of Case/ Procedure: □ Low/Easy □ Moderate/Average □ High/Difficult □ N/A

Number of times procedure performed by Resident: ____________________________________________

Below Above
Not Observed Satisfactory Excellent
Please grade the following areas on the given scale: Expectation Expectation
/ Applicable
1 2 3 4 5
Indications, anatomy & steps of procedure

Informed consent, with explanation of procedure and complications

Preparation for procedure
Use of Anesthesia, Analgesia or sedation
Observance of asepsis
Safe use of instruments
Use of accepted techniques
Management of unexpected event (or seeks help)
Post-procedure instructions to patient and staff
Professionalism
Overall ability to perform whole procedure

Assessor's Satisfaction with DOPS:

(Low) 1 2 3 4 5 (High)
Resident's Satisfaction with DOPS:
(Low) 1 2 3 4 5 (High)
Strengths Suggestions for Improvement

Encounter to be repeated □ YES □ NO

Signature
GUIDELINES FOR PROCEDURE-SPECIFIC DOPS ASSESSMENT

 Intra-oral / Extra-oral interrupted silk suture

 Aseptic measurement, types/ strength of suture
 Suture, equal depth and distance from incision line on both sides, approximation.
 Passage of needle, knot tying
 Tissue closer (suture) without tension
 Knot should never lie on incision line
 Averted wound margin
 Appropriate selection and use of instruments: Retractor size, Tooth forceps, Scissor, Curved
cutting suture, Needle holder

 Incision, Flap design (Intra-orally)

 Flap of proper size, shape
 Incision on sound bone
 Pen grasp of scalpel for intra-oral incision
 Continuous (layer by layer) stroke of blade
 No sharp angles of incision
 Broad-based flap, good access
 Appropriate selection and use of instruments: Blade number, Retractor size, Tooth forceps,
Dissecting scissor, Periosteal elevator

 Local Anaesthesia (Infiltration, Block)

 Infiltration of maxillary site
 Site of mandibular block
 Land mark of mandibular nerve
 Effectiveness of Anaesthesia
 Appropriate selection and use of instruments: Syringe, Cartridge, Retractor

 Biopsy (Incisional)
 Anesthesia 1 cm away from lesion
 Tissue stabilization
 Lesion and normal tissue piece provide material for evaluation
 Incision should be parallel to the course of nerve, arteries
 Handling of tissue and hemostasis
 Identification of surgical margin
 Specimen care and biopsy data sheet
 Appropriate selection and use of instruments: Blade number, Syringe, Cartridge, Retractor,
Suture, Needle holder, Scissor, Hemostatic material, Jar with preserving agent
 Arch bar application
 Size and design (with or without hook) of eyelets
 Interdental passage, tightness, strength
 Appropriate selection and use of instruments: Stainless steel wire / 0.45, Arch bar with and
without hooks, Wire holders, Wire cutter, Retractor, Proper light
 Eyelets application
 Size and design of eyelets
 Interdental passage, tightness, strength
 Fracture site eyelets passage
 Appropriate selection and use of instruments: Stainless steel wire / 0.45, Wire holders, Wire
cutter, Retractor, Proper light

 Removal of impacted mandibular molar

 Incision, reflection flap for accessibility, design of flap
 Removal of overlying bone with bur, chisel
 Sectioning of the tooth required or not
 Delivery of sectioned tooth with elevator
 Debridement of wound and wound closure
 Appropriate selection and use of instruments: Blade number, Syringe, Cartridge, Periosteal
elevator, Round and Fissure Surgical bur, Surgical hand piece with motor, Extraction forceps,
Cyrier, Retractor, Suture material with Needle holder, Scissor, Proper light

 Surgical Endodontics / Peri-apical surgery

 Anaesthesia and flap design
 Incision and refection
 Peri-apical exposure, curettage, Apical root sectioning, irrigation
 Flap replacement and suturing
 Appropriate selection and use of instruments: Blade number, Cartridge, Periosteal elevator,
Curette, Surgical bur, Surgical hand piece, Motor, Retractor, Suture with Needle holder,
Scissor, Proper light

 Pre-prosthetic (Mandibular ridge contouring)

 Anaesthesia and flap design
 Incision and refection
 Exposure, filing or burring, irrigation
 Flap repositioning and suturing
 Appropriate selection and use of instruments: Blade, Cartridge, Periosteal elevator, Bone
cutter, Bone nibbler, Bone file , Surgical bur, Surgical hand piece with Motor, Retractor,
Proper light

 Enucleation of Cyst
 Anaesthesia and flap design
 Incision and refection
 Incision on normal bone
 Exposure of cyst linning with bur, chisel
 Periosteal enucleation of cyst wall
 Curettage, debridement, dead space management
 Closure of wound, stitches, packing, dressing
 Appropriate selection and use of instruments: Blade, Cartridge, Periosteal elevator, Bone
nibbler, Surgical burs, Surgical hand piece with Motor, Retractor, Proper light , Suture with
Needle holder, Hemostatic agents
 Marsupialization of Cyst
 Anaesthesia and flap design
 Incision and refection
 Incision on normal bone
 Exposure of cyst with bur, chisel
 Marsupialization of cyst wall
 Closure of wound after putting and securing 2 tube for wash and drainage
 Appropriate selection and use of instruments: Blade, Cartridge, Periosteal elevator, Bone
nibbler, Surgical burs, Surgical hand piece with Motor, Retractor, Proper light, Suture with
Needle holder, Hemostatic agents, Tube